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Eur Heart J. 2014 Oct 7;35(38):2627-38. doi: 10.1093/eurheartj/ehu256. Epub 2014 Jul 25.

Open issues in transcatheter aortic valve implantation. Part 1: patient selection and treatment strategy for transcatheter aortic valve implantation.

Author information

1
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands j.j.bax@lumc.nl.
2
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands.
3
Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK.
4
Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
5
Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
6
Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Essen, Germany.
7
Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
8
Erasmus Medical Center, Rotterdam, The Netherlands.
9
St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
10
Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital, New York, USA.
11
Cardiovascular Department, King's College Hospital, London, UK.
12
Interventional Cardiology, McGill University Health Center, Montreal, Canada Cardiovascular Surgery, German Heart Center Munich, Bavaria, Germany.
13
Quebec Heart and Lung Institute, Québec, Canada.
14
Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, TX, USA.
15
Department of Cardiology, Laval University, Quebec, Canada.
16
Bichat Hospital, University Paris VII, Paris, France.
17
Cardiac Imaging Department, University Hospital Ramon y Cajal, Madrid, Spain.
18
Department of Cardiology, Bern University Hospital, Bern, Switzerland.

Abstract

An exponential increase in the use of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis has been witnessed over the recent years. The current article reviews different areas of uncertainty related to patient selection. The use and limitations of risk scores are addressed, followed by an extensive discussion on the value of three-dimensional imaging for prosthesis sizing and the assessment of complex valve anatomy such as degenerated bicuspid valves. The uncertainty about valvular stenosis severity in patients with a mismatch between the transvalvular gradient and the aortic valve area, and how integrated use of echocardiography and computed tomographic imaging may help, is also addressed. Finally, patients referred for TAVI may have concomitant mitral regurgitation and/or coronary artery disease and the management of these patients is discussed.

KEYWORDS:

Aortic stenosis; Coronary artery disease; Imaging; Mitral regurgitation; Patient selection; Transcatheter aortic valve implantation

PMID:
25062952
DOI:
10.1093/eurheartj/ehu256
[Indexed for MEDLINE]
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